Universal screening and management debate

Contributor: Aaron Lessen, MD

Educational Pearls:

Blunt cerebrovascular injury (BCVI)

• BCVI is a traumatic injury to the carotid or vertebral arteries

• Patients may initially have no neurologic symptoms

• In some cases, a thrombus can form at the site of the injury and later cause ischemic stroke, sometimes hours after the original trauma

• CT angiography (CTA) of the neck is a useful screening tool for BCVI

• HIstorically, CTA was reserved for patients with high-risk mechanisms or neurologic symptoms

• CTA screening has expanded as understanding of BCVIs and their prevention progresses

• The Denver criteria were developed to identify patients with increased risk for BCVI

• High-risk findings include cervical spine injuries and severe facial or skull-base fractures

• Screening practices still vary between trauma centers, though expansion of proactive CTA is an increasingly common practice

References

1. Kim DY, et al. Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2020.

2. Biffl WL, et al. Screening for and treatment of blunt cerebrovascular injuries: Western Trauma Association critical decisions algorithm. J Trauma. 2009.

3. Brommeland T, et al. Best practice guidelines for blunt cerebrovascular injury. Scand J Trauma Resusc Emerg Med. 2018.

4. Harper PR, et al. Routine CTA screening identifies blunt cerebrovascular injuries missed by clinical risk factors. Trauma Surg Acute Care Open. 2022.

Summarized by Sam Pahl | Edited by Sam Pahl & Ahmed Abdel-Hafiz, NREMT-P

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